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| FIGURE 1 | FIGURE 2 |
The family physician (FP) diagnosed a single hammertoe deformity (FIGURES 1 and 2). Hammertoe deformity is the most common digital deformity, and it can affect up to 60% of adults. The second digit is most commonly affected. Conservative measures include:
- change in shoes
- padding to limit shearing force from shoes
- splinting (in an early, flexible hammertoe)
- steroid injection into the metatarsophalangeal (MTP) joint for a patient who complains of joint pain secondary to early-stage osteoarthritis or capsulitis. (However, avoid excessive steroid injections, as these can result in further damage of the capsule and worsening of the deformity)
- custom-made orthoses to slow down the progression of the deformity if it is caused by biomechanical factors
- resting, nonsteroidal anti-inflammatory drugs, and ice for an inflamed joint and/or shoe irritation.
In this case, the patient was referred to a podiatrist, who fused her proximal interphalangeal joint and released her extensor tendon and dorsal capsule at the MTP joint to reduce the deformity. The plantar plate was also repaired.
The patient started protective ambulation with a surgical shoe on the third postoperative day. An internal fixation wire, which was used to fixate the fusion site, was removed 4 weeks later.
The patient returned to work and her regular activities within 6 weeks of the operation. Based on her history and the findings at surgery, it appeared that she had a rupture of the plantar plate from overuse, which resulted in a hammertoe deformity of her second digit.
Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Images courtesy of Naohiro Shibuya, DPM. This case was adapted from: Shibuya N, Fontaine J. Hammertoe deformities. Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:900-903.
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